title: Does altering inclination alter effectiveness of treadmill training for gait impairment after stroke? A randomized controlled trial.
abstract: OBJECTIVE
  To assess whether a downhill walking training programme is more effective than the same amount of training applied uphill in chronic stroke survivors.
  
  
  METHODS
  Randomized, single-blind study.
  
  
  METHODS
  Outpatient rehabilitation service.
  
  
  METHODS
  Thirty-eight adults with hemiplegia from stroke lasting more than three months were randomly allocated to one of the two groups: 'UP' - 45 minutes of physical therapy + 30 minutes of treadmill with 5% ascending slope; and 'DOWN' - 45 minutes of physical therapy + 30 minutes of treadmill with 5% descending slope. Both groups were treated 5 times a week for six weeks. Patients were evaluated before treatment, at the end of treatment and after three months.
  
  
  METHODS
  Primary outcome measure was the number of patients showing an improvement in 6-minute walking test (6MWT) greater than 50 m. Secondary outcome measures were: (1) number of patients showing a clinically relevant improvement of gait speed during 10-m walking test (10mWT); (2) number of patients showing an improvement in timed up and go (TUG) greater than minimal detectable change.
  
  
  RESULTS
  Both groups had a significant improvement after treatment and at follow-up. At the end of treatment, compared to UP group, more patients in the DOWN group showed clinically significant improvements in primary and secondary outcomes (16/19 patients for 6MWT, 11/19 patients for 10mWT and 9/19 patients for TUG compared with 3/19, 4/19 and 2/19 patients, respectively, P < 0.01). At follow-up, results were similar except for 10mWT.
  
  
  CONCLUSIONS
  In chronic stroke patients, downhill treadmill training produces a bigger effect than uphill training.
authors.affiliation: Department of Neuropsychology and Neurorehabilitation, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. stefano.carda@chuv.ch
authors.forename: Stefano
authors.initials: S
authors.lastname: Carda
authors.forename: Marco
authors.initials: M
authors.lastname: Invernizzi
authors.forename: Alessio
authors.initials: A
authors.lastname: Baricich
authors.forename: Gianluca
authors.initials: G
authors.lastname: Cognolato
authors.forename: Carlo
authors.initials: C
authors.lastname: Cisari
mesh_terms: D005081:Exercise Therapy / Q000295:instrumentation / Q000379:methods*; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D007558:Italy; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D016138:Walking / Q000502:physiology*
keywords: Exercise; slope; treadmill training